Is there a consensus regarding antifebrile medication use for mid-grade fevers?
March 8, 2011 3:15 AM Subscribe
Is there a general consensus in the medical world regarding whether it is better or not to use fever reducing medications (aspirin, acetaminophen, ibuprofen, etc.) for medium-grade fevers?
I know that there are medical opinions regarding whether or not to use fever reduction medications for medium fevers, backed up by rational, logical reasoning. The problem is, both from Internet research and consultation with actual doctors, I have heard perfectly cromulent arguments stated by doctors on both sides. So my question isn't really "should they be used" as much as "is there a medical consensus (10/90 or the like) or an overwhelming trend (30/70) or is opinion generally divided (50/50)?" (plus, of course, which sides are which on those divisions).
I know that there are medical opinions regarding whether or not to use fever reduction medications for medium fevers, backed up by rational, logical reasoning. The problem is, both from Internet research and consultation with actual doctors, I have heard perfectly cromulent arguments stated by doctors on both sides. So my question isn't really "should they be used" as much as "is there a medical consensus (10/90 or the like) or an overwhelming trend (30/70) or is opinion generally divided (50/50)?" (plus, of course, which sides are which on those divisions).
Response by poster: Sorry, yeah, should have mentioned that. There's general consensus against aspirin for kids, and general consensus about not overdosing on acetaminophen and screwing up your liver. I was thinking more along the lines of "general consensus against reducing fevers through proper age-appropriate medications in proper quantities, used as directed, etc."
posted by Bugbread at 4:10 AM on March 8, 2011
posted by Bugbread at 4:10 AM on March 8, 2011
A recent (last two weeks) American Academy of Pediatrics guideline now states that for children, fevers do not need to be controlled if the child feels well. A fever is a normal response to infection. If the child refuses to eat or isn't sleeping or is really cranky, then reducing the fever might make them feel better -- well enough to take in more fluids to prevent dehydration, for example.
Honestly, the vast majority of opinions are generally divided in medicine. There is wide variation in practice. You can see one physician and get a whole workup, and a second physician will reassure you and send you home.
That being said, administering antipyretics is frequently a "critical action" for emergency physicians in our oral board scenarios.
posted by gramcracker at 4:12 AM on March 8, 2011 [2 favorites]
Honestly, the vast majority of opinions are generally divided in medicine. There is wide variation in practice. You can see one physician and get a whole workup, and a second physician will reassure you and send you home.
That being said, administering antipyretics is frequently a "critical action" for emergency physicians in our oral board scenarios.
posted by gramcracker at 4:12 AM on March 8, 2011 [2 favorites]
You also have to throw in the fact that even if a lot of physicians aren't convinced they do anything medically, when people come to the doctor with a complaint, they want the doctor to do something. Prescribing a cheap medication of equivocal effectiveness which is otherwise harmless can go a long way towards getting people to settle down and go home without costing anyone more resources than that.
posted by valkyryn at 5:13 AM on March 8, 2011 [1 favorite]
posted by valkyryn at 5:13 AM on March 8, 2011 [1 favorite]
As a nurse in the hospital, I see a lot of patients whose doctors write orders for Tylenol in case they develop a fever > X (usually somewhere in the low 100.somethings), even for patients who aren't expected to develop a fever. It's there just in case. I don't know whether there's any consensus that it's actively helpful to control these low to medium-grade fevers, but it seems to be common practice. I also know that we'll control those fevers more aggressively if it's making someone uncomfortable. The chills and muscle aches that often accompany a fever can make somebody miserable, so managing those symptoms (rather than the actual body temperature) definitely seems worthwhile.
posted by vytae at 5:33 AM on March 8, 2011
posted by vytae at 5:33 AM on March 8, 2011
Best answer: As a nursing student I can tell you that the current nursing textbooks say that fever reducing medication is probably not necessary, and then go on to say that you should give them.
I just looked up the entry for "pathophysiology and treatment of fever in adults" on uptodate (the main website used as a reference by US doctors - evidence based and updated every 3 months) and they say, "Although a rapid reduction in elevated core temperature due to hyperthermia is mandatory, treatment of fever is often a debated issue." and "The vast majority of fevers are associated with self-limited infections, most commonly of a viral origin, where the cause of the fever is easily identified. The decision to reduce fever with antipyretics assumes that there is no diagnostic benefit of allowing the fever to persist. However, there are clinical situations in which observation of the pattern of fever can be helpful diagnostically." and finally, "There are many reports on the beneficial effect of elevated temperature (febrile range) in animals during infectious challenges. In addition, in vitro cultures of animal or human cells at elevated temperature are supportive of a heightened immune response as well as increased bactericidal killing. However, there are no studies that fever itself facilitates the recovery from infection or acts as an adjuvant to the immune system."
In short, there is no consensus, but in my experience the reality is that most providers do recommend treating fevers - although the other reality is that is mostly for reasons of comfort.
A term you may want to use in your googling is "antipyretic"
posted by serazin at 9:18 AM on March 8, 2011 [2 favorites]
I just looked up the entry for "pathophysiology and treatment of fever in adults" on uptodate (the main website used as a reference by US doctors - evidence based and updated every 3 months) and they say, "Although a rapid reduction in elevated core temperature due to hyperthermia is mandatory, treatment of fever is often a debated issue." and "The vast majority of fevers are associated with self-limited infections, most commonly of a viral origin, where the cause of the fever is easily identified. The decision to reduce fever with antipyretics assumes that there is no diagnostic benefit of allowing the fever to persist. However, there are clinical situations in which observation of the pattern of fever can be helpful diagnostically." and finally, "There are many reports on the beneficial effect of elevated temperature (febrile range) in animals during infectious challenges. In addition, in vitro cultures of animal or human cells at elevated temperature are supportive of a heightened immune response as well as increased bactericidal killing. However, there are no studies that fever itself facilitates the recovery from infection or acts as an adjuvant to the immune system."
In short, there is no consensus, but in my experience the reality is that most providers do recommend treating fevers - although the other reality is that is mostly for reasons of comfort.
A term you may want to use in your googling is "antipyretic"
posted by serazin at 9:18 AM on March 8, 2011 [2 favorites]
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posted by Blazecock Pileon at 3:44 AM on March 8, 2011